HomeMy WebLinkAbout24-8914 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-8914 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 3 2$
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# 6 0
COLLISION.. OS - 24 - 2024 0740 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE PETROVITSKY RD BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 116THAVESE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4253246002 0 3 30
6� LAST NAME THOMPSON FIRSTNAME TERRY MIDDLE W 1 1 2 31
INITIAL
STREET ❑ 2032 DAYTON DR SE CITY RENTON ST WA ZIP 980554564 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEXI ID
M MD-O B 12 1— 14 — 1943 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES 2❑
USE CLASS LEFT SHOULDER AND NECK PAIN
3
10❑ LI QTNFS# BOB3260 STATE WA VIN#' 1 C4PJMLX8KD288079
- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 7 34
13 2 2019 JEEP CHERO UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO TERRY THOMPSON 2032 DAYTON DR SE RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI V INSURANCE INSURANCE CO ALLSTATE 964 884 388 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ LEGALLY STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064608959
16 a
LAST NAME HOLCEY FIRST NAME JAIDYNN MIDDLE A
INITIAL
17❑ STREET ❑', 10607 SE 250TH PL UNIT I-306 CITY' KENT ST WA ZIP 98030 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. O6 _ 08 _ 2004 39
LICENSE# MMDDYY
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR y EJECT 1 WE USE 9 CLASS 6 SORE FOREHEAD ❑
21❑ LICENSE I CFE1766 TATe WA VIN# W04GM6SX8J1116326
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE BUIC MODEL REGAL STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JAIDYNN HOLCEY 10607 SE 250TH PL UNIT I-306 KENT WA 98030 D:2064608979 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO vE""Le ❑ ,J� CITATION# CHARGE C�Q
LEGALLY YES N`[]
25 BADJ s a
OFFICER'S NAME(PRINT) OFFICER PHONE GE OR ID# AGENCY
26
JESSE VANDERHOEK 11631 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF08372
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8914
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MCKERN MADILYN L
(LAST FIRST,
ADDRESS&PHONE# D O.B.
25026 188TH AVE SE COVINGTON WA 98042 2533919867 SEXi F MMDDYyry 10 - 04 - 2003
PASSENGER WITNESS� UNIT# SEAT : AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ i'!I POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) DUKUREH MAHAMADOU
ADDRESS&PHONE# D O B
COVINGTON 2066969905 SEX M MMDDYVYY 05 _ 12 _ 1996
PASSENGER []WITNESS POS. USE CLASS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Per a witness and per a verbal statement from the driver of vehicle #2, vehicle #1 was traveling at a
high rate of speed southbound on 116th Ave SE approaching SE Petrovitsky Rd. Vehicle #2 was
traveling eastbound in the left turn lane on SE Petrovitsky Rd approaching 116th Ave SE. Both the
witness and the driver of vehicle #2 advised vehicle #2 had a green left turn arrow to turn left onto
116th Ave SE. Vehicle #1 drove through the red traffic light at this intersection, causing the front right
side of vehicle #1 to collide with the front end of vehicle #2. Vehicle #2 was disabled from the
collision. Vehicle #1 had severe damage to the front right side of the vehicle, but vehicle #1 still fled
the scene westbound on SE Petrovitsky Rd without first exchanging information with the driver of
vehicle #2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 08-24-24 06:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 8/25/2024 4:36:15 PM
BADGE OR ID# 11631 ORI# WA0171300 TIME POLICE DISPATCHED 7:45 AM TIME POLICE ARRIVED 7:54 AM
FART I PAGE IT]OF 3�
REPORT NO. EF08372 CASE# ' 24-8914 DATE AND TIME 08/24/24 07:40
OF COLLISION
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